Gluten

My daughter is a barista. She came home from work recently and said, “One of the customers came in today and wanted to know if our hot tea was ‘gluten-free’. Seriously? It was all I could do to keep from asking her if she knew what tea was made of!”

Gluten sensitivity is a hot topic these days as illustrated by a recent article in the New York Times “Gluten Free-whether you need it or not“. I have many patients who are curious about gluten-free diets. Patients are trying them and losing weight, having fewer migraines, reducing PMS symptoms, getting more energy, and/or making allergies going away. After having been in medicine for a sufficient number of years the exuberance of interest in gluten reminds me of any number of healthcare fads. Because we are human we hope to find an easy answer to our lifestyle problems. When patients ask me what I think, my answer is usual a verydefinitive “I have no idea.” Then I elaborate since that tends to be disconcerting to them. First I need to know exactly why they are asking. Do they have symptoms of celiac disease: constipation, diarrhea, nausea, weight loss and abdominal pain (which can be caused by any number of entities besides celiac sprue)? Have they read something on the Internet or heard from a friend about gluten sensitivity and believe they have a problem? Are they presently following a gluten-free diet and if so, for how long and how do they feel? Only after I know where my patient is coming from can I decide where I need to go with her in the context of the visit.For most individuals I want to be reassured that they are eating a nutritionally balanced diet and beyond that, I don’t have easy answers. Usually I find questions like this involve a bit of fact, some fad and most definitely the hope that this “latest thing” will solve their problem, whatever that problem may be. In terms of my response, most things in medicine, like life, are best answered sensibly: All things in moderation.